Journal of Trauma Publishes Paper on Time and Place of Death From Automobile Crashes

Journal of Trauma Publishes Paper on Time and Place of Death From Automobile Crashes

October, 2016

Dear Care for Crash Victims Community Members:

Dr. Howard R. Champion, a surgeon who has worked to improve care for crash victims since at least 1986, has a new paper out in the Journal of Trauma (attached).

Short History of Efforts To Improve Care for Crash Victims

I have had the honor to work with Dr. Champion over the years.  A little background information.

1980’s – By 1980 the U.S. had lost 2.2 Million Lives to Vehicle Violence Dr. Champion was co-author of the landmark 1989 Journal of Trauma paper “Trauma Triage: Vehicle Damage as an Estimate of Injury Severity”.  See  

At NHTSA, his work was very highly regarded and listed in CIREN Report HS 809 564 pp. 107 – 110.  Available at

1990’s – By 1990 the U.S. had lost 2.7 Million Lives to Vehicle Violence Dr. Champion’s work in the 1980s contributed to the American College of Surgeons’ 1990 publication “Resources for the Optimal Care of the Injured Patient.”  In 1991, NHTSA faced a mystery of an air bag fatality that turned out to be an airbag success story – albeit a tragic story.  NHTSA had assigned me to manage a Congressional earmark project to build a Trauma Center in Miami, FL.  A small percentage of the project funding was allocated to research on crashes, injuries, treatments and outcomes.  One objective was to observe how new airbags coming into the fleet were performing. As NHTSA investigated its first air bag fatality on my project, NHTSA R&D became intensely aware of the need to improve triage, transport, and treatment decision-making for saving crash victims.  The Trauma Center had not yet been built and the crash victim was transported to the massive Jackson Memorial Hospital.  The crash victim had been in a very high severity multiple impact crash in a 1991 Volvo traveling at an estimated 60 mph into a traffic control box and then into a concrete pole.  He was unbelted and weighed 323 lbs.  He was initially stable.  He was later taken to the operating room for seemingly correctable problems.  He deteriorated, developed severe problems, found to have massive internal injuries and died of multiple organ system failure.

At NHTSA our focus was on the engineering of the Volvo airbag.  We brought together the leading bio-mechanics and airbag engineers to understand what caused the injuries.  We spent a year trying to determine whether the airbag was improperly designed, did the airbag go off on the first impact or the second impact, was the victim on the airbag when it went off?  Etc.  It turns out that the limits the Volvo airbag was designed for was about a 60 mph barrier impact for a belted, average size male – not an unbelted 323 lb. male in a multiple impact crash with the second impact into a concrete pole.
When I told a trauma surgeon from Baltimore about our engineering mystery, he pointed out that the emergency medical system including the hospital failed to immediately recognize the presence and severity of the internal injuries.   At the hospital, they did not know how severe the crash was because he lacked major facial injuries that were usually were present in severe crashes.  That led to Dr. Jeffrey S. Augenstein et al describing the challenge of identifying occult injuries in air bag protected crash victims.  See Case #91-002 inattached SAE paper 940714.

In 1993, NHTSA published a Research Note, that I co-authored, titled  “Detection of Internal Injuries in Drivers Protected by Air Bags”  See p. 37  at

In 1994, NHTSA published a poster for the Emergency Medical community titled “Look Beyond the Obvious” to help detect internal injuries in air bag equipped vehicles.   See CIREN Progress Report #2, Pages 37-45 at
In 1996, NHTSA Administrator Ricardo Martinez, the agency’s first emergency physician to head the agency, asked me to manage a research project with Dr. Champion as Principal Investigator to examine the relationships of crash characteristics to injuries.  I had the privilege of bringing together a team of high level medical and safety researchers.  We met monthly for a year analyzing available NHTSA data on crashes, injuries, and outcomes.
In 1997, Dr. Champion presented findings that it was possible to estimate the probability of the presence of serious injuries from crash data to the Administrator and top NHTSA executives – including demonstration of an URGENCY 1.0 algorithm.   The continued development of an URGENCY algorithm was recommended for improving post-crash injury control.  See  And see
Based on this work, I helped in the publication of papers by the team members on Automatic Crash Notification (ACN), URGENCY, and Air Medical Services.  See

In 1998, the research team produced the paper on Automatic Crash Notification published in AirMed.  See

In 1999,  the team’s paper on URGENCY was published in AirMed.  See

In 1999, Dr. Champion presented a paper to the NTSB titled “Reducing Highway Deaths and Disabilities with Automatic Wireless Transmission of Serious Injury Probability Ratings from Crash Recorders to Emergency Medical Services Providers.”  See
In October 1999, the Congress, based in part on this research, enacted the Wireless Communications and Public Safety Act specifying 9-1-1 to be the “universal emergency telephone number” and finding that “emerging technologies can be a critical component…to reduce emergency response times and provide appropriate care.” In 1999, the FCC also issued rules for Enhanced 9-1-1 service to automatically provide location information to emergency dispatchers.
2000’s – By 2000 the U.S. had lost 3.1 Million Lives to Vehicle Violence
In 2001, NHTSA published an evaluation report on a limited test of Automatic Crash Notification (ACN).   See
In 2001, NHTSA published a paper “Development and Validation of the URGENCY Algorithm to Predict Compelling Injuries”  See
In 2001, NHTSA published CIREN Report #1, which I edited, that carried chapters on the continuation of work on crashes, injuries, treatments, and outcomes to reduce deaths and disabilities.  See
In 2003, NHTSA published a paper on the creation of the Atlas and Database of Air Medical Services (ADAMS) to help improve rescue of seriously injured crash victims to get them to definitive (timely and optimal) care at trauma centers.  See
In 2003, NHTSA published CIREN Report #2, which I edited, that carried chapters on improving care for crash victims at Trauma Centers.  It summarizes much of the work.  See pp.37-45 at
In 2005, NHTSA published a paper by Dr. Champion and the team “New Tools to Reduce Deaths and Disabilities by Improving Emergency Care: Urgency Software, Occult Injury Warnings, and Air Medical Services Database”.  See
In 2005, another team of researchers I worked with produced a paper “Assessment of Air Medical Coverage Using the Atlas and Database of Air Medical Services and Correlations With Reduced Highway Fatality Rates”.  This paper indicated the life saving potential for the ADAMS GIS by providing the data and software tools needed to enable users to view the air medical resources in this country on national, state, and local levels. See

By 2006, under the Bush Administration, NHTSA had reassigned me to work that appeared to me to have less promising life saving potential.  I thought that I should retire and work on improving care for crash victims.

By 2007, GM had funded work at CDC to remove “Rollover and Extrication” from new Triage Guidelines.  See

By 2009, Dr. Champion had a paper published in the Journal of Trauma noting the importance of “Rollover and Extrication” in Triage Guidelines.  See

By 2009, BMW had shown what was possible with Automatic Crash Notification, URGENCY software, and communications with trauma centers and air medical services.  Watch video at

2010’s – By 2010 the U.S. had lost 3.5 Million Lives to Vehicle Violence

By 2015, the NHTSA data showed that both the number and percent of fatalities counted by NHTSA that died pre-hospital exceeded those that died in hospital.  See

JS Final NHTSA Vehicle Deaths GraphData Percentages States 06-15-15-1 2015 at In 2015, Dr. Champion’s paper “Time and Place of Death from Automobile Crashes” was published by the Journal of Trauma.  Copy attached.  It shows that time and place of death data continue to support calls for improvements in the triage, transport, and treatment decisions of people seriously injured in crashes.

By 2016, twenty five years later, – and nearly 1 million American lives lost and nearly 4 million serious injuries later – NHTSA still has not published a federal minimum vehicle safety standard FMVSS for ACN, URGENCY software, and communications and dispatch protocols to trauma centers and air medical services when crashes have a high probability of presence of serious injuries.  This despite 100 deaths per day and 400 serious injuries per day in the U.S.A. today.  See

NHTSA has failed the American people.   After 25 years, 56% of all deaths due to vehicle violence still occur without transport to any facility for emergency medical care.  And of the 44% that are taken to “some” facility, not necessarily a trauma center for optimal care, many die for lack of timely and optimal care.

The science and safety technologies have been there for decades.  The needless deaths and suffering continue.

Lou Lombardo

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